The Pain of Sprains and Strains
Approximately 40 million children 6 years of age and older participate in organized sports. Participation in sports provides many benefits for children, including increased physical fitness and development of new skills, including an opportunity to make new friends while learning the values of teamwork and cooperation.
Increasingly, children are specializing in specific sports at younger ages. While this allows children to improve sport-specific skills, it also places them at a higher risk of injury. It is estimated that about 2.6 million pediatric emergency department visits last year were related to sports injuries.
Strains and sprains account for the majority of minor sports-related injuries. A strain is caused by excessive stretching and tearing of a muscle. Sprains are caused by stretching and tearing of the ligaments that connect and stabilize our bones at the joints. Sprains are classified into three different groups: Grade I, Grade II and Grade III. Grade I sprains are caused by minor stretching of the ligaments and often only cause slight pain or discomfort with movement. Grade II sprains involve a partial tear of the ligaments. Pain, swelling and minimal to moderate decrease in the ability to use the affected joint are typically seen. Grade III sprains are classified by a complete tear of the ligament. This leaves the joint loose and unstable and causes the child to have significant swelling, bruising and pain with slight movements. The most commonly sprained joints in children are the ankle and wrist.
Initial treatment of sprains and strains involves rest, ice, compression and elevation, which can be remembered with the aid of the acronym R.I.C.E. The goal of R.I.C.E. is to decrease inflammation and swelling at the injury site. Ice should be used immediately after the injury. Use a towel or soft cloth between the ice and joint to prevent damage to the child’s skin. Ice should be applied for 20 minutes at a time, every two to three hours as needed for pain. An appropriately sized elastic wrap or splint should be placed on the injured joint to provide added support and compression. Elevating the injured joint above the level of the heart works to prevent excess blood and fluid from accumulating, decreasing swelling. Children should rest the affected joint for a minimum of 48-72 hours. In addition to the R.I.C.E. regimen, ibuprofen is effective in relieving pain and decreasing inflammation. Tylenol, or acetaminophen, provides pain relief but has no anti-inflammatory effects.
It is important to note that children’s bones are immature and still growing. In fact, the ligaments of younger children are stronger than the bones they connect. Therefore, the younger the child, the more likely they are to have an underlying broken bone after a seemingly minor injury. Of important note, the growth plate, which is the site of bone lengthening, is especially vulnerable to fracture. It is therefore important to bring children to a doctor’s office or emergency room for further evaluation of the injury by a trained medical specialist.
Dr. Mark Henin is a resident pediatrician at Carolinas Medical Center, and Dr. Erin Stubbs is a board-certified pediatrician at CMC Myers Park Pediatrics.